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A Road To Recovery For Health Care |
| Sun February 4th, 2007 |
Bill Curry
State Senate President Pro Tem Donald Williams wants to fix health care. So do President Bush, Gov. M. Jodi Rell, New York Sen. Hillary Clinton, Illinois Sen. Barack Obama, Democrats in Congress and a long list of others. Williams' proposal, though flawed, is the best of the bunch.
There isn't much competition. Bush is peddling a health care tax deduction and a small subsidy for consumers buying private insurance. He pays for the tax deduction by raising middle-class taxes. (For 20 percent of taxpayers, he claims, but you can bet it's more.) He pays for the subsidy by raiding budgets of other health care programs. (He doesn't say which ones.)
Democrats in Congress are puttering around with stem cell research and prescription drug prices. As with Iraq, they seem otherwise content to let Bush take the risks and the hits. Should they persist in this vein, they can anticipate a revolt from within their own party.
Obama and Clinton don't really have plans. Obama says we can have universal coverage in six years but doesn't say how. Clinton says about that much, adding only that this time around she means business.
Gov. Rell wants insurers to offer cut-rate plans to people who don't have much money and don't plan on getting very sick. One guesses she hatched the idea with insurers, but so far they haven't said they'll do it. No matter. The plan has high co-pays, deductibles and other trap doors. It doesn't cut costs; instead, it grafts its meager benefits onto a system that can't deliver on present obligations.
Rell is so lost in the woods she'll be lucky if birds don't eat her bread crumbs. It will be six years at least before Washington acts. So what's in Williams' proposal?
In year one, it could cover 140,000 people, about 40 percent of the state's uninsured. It would do so by expanding state/federal programs for low-income families with children. The price tag is $450 million, with the feds reimbursing half. In short, it solves a big part of the problem, but for a big chunk of change.
Uniquely, Williams tends to the neediest first while calling for a study of the uninsured middle class. He explains: "After careful study I am convinced we must work toward a Medicare-for-all type program that brings better quality, simplicity and affordability to all our citizens."
Williams grasps two core principles:
1. You can't have universal health care without massive cost-cutting.
2. You can't cut costs without a bigger role for government. The old ramshackle employer- and private-insurer-based system can no longer carry the load.
Our current system simply costs too much to run. If we keep it, we can either pay a lot and fix a little or pay a little and fix nothing. Do the math:
Nearly a third of every health care dollar goes to overhead, double what any other country spends. Insurers take 20 percent off the top, but Medicare pushes its paper for about 5 cents on the dollar.
By 2010, America's health care spending will reach $3 trillion, including a trillion for overhead. At current rates, we can cover every one of our 47 million uninsured for less than $300 billion. If our overhead were as low as Canada's (16 percent) we'd save $500 billion a year. We could cover everyone and still save $200 billion. How do we know we can do it? Every other developed country in the world already has.
It's hard for Democrats to see that cutting costs is the way to universal care. Republicans can't accept that more government is the way to cutting costs. Watching Bush and Rell try to squeeze more coverage out of the old system is like watching a man beat a horse too old and tired to pull its cart. To go forward we need a whole new system.
The Universal Health Care Foundation of Connecticut has done a terrific analysis of the costs of delivering health care three different ways: by the old system, by a hybrid system and by a single-payer system. Based solely on costs, the third option wins hands down.
It's time for a debate based on arithmetic and reality, not ideology or self-interest. There's just one issue: Are the foundation numbers right? I believe we'll eventually agree they are. When we do, no matter what system we devise, Don Williams will get lots of credit for refusing to beat a dead horse.
Bill Curry, former counselor to President Bill Clinton, was the Democratic nominee for governor twice. His column appears Sundays on the Other Opinion page. He can be reached at billcurryct@gmail.com.
Copyright 2007, Hartford Courant |
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